How is a myomectomy done?

Myomectomy removes fibroids and leaves the uterus in place. It can be done through the vagina and cervix (hysteroscopy), through small cuts in the belly (laparoscopy), or through a larger cut in the abdomen (laparotomy).

Will my fibroids come back after a myomectomy?

The fibroids that are removed do not grow back, but new fibroids can form later.

Which route is right for me, laparoscopic or open myomectomy?

In randomized trials, laparoscopic myomectomy meant less reported pain right after surgery, less fever, and a shorter hospital stay than open surgery, with no clear difference in the chance of needing to convert to another approach or return to the operating room. Ask which route is being planned for you and why.

What is the plan for blood loss, and might I need a transfusion?

Some medicines and surgical techniques used during myomectomy reduced blood loss in trials, though most of that evidence is low quality, so it is reasonable to ask your surgeon what the plan is for managing bleeding. No published transfusion rate by surgical route is cited here, so ask your surgeon directly how likely a transfusion is for your surgery.

Will I take any medicine before surgery?

Medicine given before surgery, such as a GnRH agonist, may shrink the uterus and raise blood counts, but it can also cause more side effects. Ask whether this applies to you.

How will the fibroid tissue be removed, and is morcellation used?

The FDA recommends using a containment system during power morcellation and advises against power morcellation for "women over 50 years of age having a myomectomy or hysterectomy for uterine fibroids," because it can spread an unsuspected cancer. Ask your surgeon how fibroid tissue will be removed.

Could something unexpected be found in the pathology report?

A cancer that looks like a fibroid cannot always be found before surgery, which is part of why tissue removal and pathology findings are worth asking about. Ask what happens if the pathology report finds something unexpected, and how you would be told.

Could I need a hysterectomy instead of, or in addition to, a myomectomy?

No published rate for this is cited here. Ask your surgeon directly how likely this is in your case, and what would make it more likely.

How likely am I to need another procedure later?

No published rate for this is cited here. Ask your surgeon how recurrence and reoperation are tracked after myomectomy, and what would prompt another procedure.

I may want to get pregnant. Is myomectomy right for me?

A 2017 US fertility-society guideline says myomectomy "may be considered" to improve pregnancy outcomes when fibroids distort the uterine cavity, even when they cause no symptoms, and notes there is not enough evidence to say fibroids generally lower the chance of pregnancy. Read fertility after fibroid treatment for more on C-section and timing-to-conceive questions, and talk with your doctor.

How does myomectomy compare with UFE or hysterectomy?

Each option has different trade-offs for recovery, fertility, and the chance of needing another procedure. Read UFE vs myomectomy, questions to ask before hysterectomy, and questions to ask before UFE to prepare separate questions for each conversation.

Questions to Ask Before a Myomectomy

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How is a myomectomy done?

Myomectomy removes fibroids and leaves the uterus in place. It can be done through the vagina and cervix (hysteroscopy), through small cuts in the belly (laparoscopy), or through a larger cut in the abdomen (laparotomy)^1,2.
Will my fibroids come back after a myomectomy?

The fibroids that are removed do not grow back, but new fibroids can form later^2,3.
Which route is right for me, laparoscopic or open myomectomy?

In randomized trials, laparoscopic myomectomy meant less reported pain right after surgery, less fever, and a shorter hospital stay than open surgery, with no clear difference in the chance of needing to convert to another approach or return to the operating room⁴. Ask which route is being planned for you and why.
What is the plan for blood loss, and might I need a transfusion?

Some medicines and surgical techniques used during myomectomy reduced blood loss in trials, though most of that evidence is low quality, so it is reasonable to ask your surgeon what the plan is for managing bleeding⁵. No published transfusion rate by surgical route is cited here, so ask your surgeon directly how likely a transfusion is for your surgery.
Will I take any medicine before surgery?

Medicine given before surgery, such as a GnRH agonist, may shrink the uterus and raise blood counts, but it can also cause more side effects⁶. Ask whether this applies to you.
How will the fibroid tissue be removed, and is morcellation used?

The FDA recommends using a containment system during power morcellation and advises against power morcellation for "women over 50 years of age having a myomectomy or hysterectomy for uterine fibroids," because it can spread an unsuspected cancer⁷. Ask your surgeon how fibroid tissue will be removed.
Could something unexpected be found in the pathology report?

A cancer that looks like a fibroid cannot always be found before surgery, which is part of why tissue removal and pathology findings are worth asking about⁸. Ask what happens if the pathology report finds something unexpected, and how you would be told.
Could I need a hysterectomy instead of, or in addition to, a myomectomy?

No published rate for this is cited here. Ask your surgeon directly how likely this is in your case, and what would make it more likely.
How likely am I to need another procedure later?

No published rate for this is cited here. Ask your surgeon how recurrence and reoperation are tracked after myomectomy, and what would prompt another procedure.
I may want to get pregnant. Is myomectomy right for me?

A 2017 US fertility-society guideline says myomectomy "may be considered" to improve pregnancy outcomes when fibroids distort the uterine cavity, even when they cause no symptoms, and notes there is not enough evidence to say fibroids generally lower the chance of pregnancy⁹. Read fertility after fibroid treatment for more on C-section and timing-to-conceive questions, and talk with your doctor.
How does myomectomy compare with UFE or hysterectomy?

Each option has different trade-offs for recovery, fertility, and the chance of needing another procedure. Read UFE vs myomectomy, questions to ask before hysterectomy, and questions to ask before UFE to prepare separate questions for each conversation.

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Questions to ask before a myomectomy